ABSTRACT
Minor hemoptysis is common in cystic brosis (CF), especially in older patients. e bleeding is usually from the bronchial arteries, two-thirds of which arise from the aorta and one-third from the mammary and intercostal vessels. Other arterial collaterals may also be a source of hemorrhage. Major hemoptysis is usually but by no means invariably associated with severe disease and is dened as 250 mL per 24 hours or 100 mL/day in a 3-to 7-day period.1 It occurs in about 7% of older patients. e US Cystic Fibrosis Foundation Patient Registry of 28,858 patients over a 10-year period showed that massive hemoptysis occurred with an annual incidence of 0.87% and overall 4.1% of patients experienced hemoptysis over a 2-year period. It is noted that 1 in 100 patients will have a massive hemoptysis annually. e patients who had major hemoptysis were older (mean age 24 years) with more severe lung disease (60% had forced expiratory volume in 1 second [FEV1] below 40% predicted). e major risk factors were Staphylococcus aureus in the sputum (odds ratio [OR], 1.3) and diabetes (OR, 1.1). Morbidity and mortality is increased aer massive hemoptysis (35% dying within 1 year and median survival aer the rst major hemoptysis 5 years, with presumably at least some of the mortality related to underlying lung disease).2
